Tag Archives: healthcare

UK healthcare standards ‘trailing rest of developed world’

The UK would need over 75,000 more doctors and nurses to match standards in the rest of the developed world, leading health experts have warned.

The quality of care in the UK is “pretty mediocre” across several key areas, while obesity levels are “dire” and the NHS struggles to get even the “basics” right, they said.

A new report from the Organisation for Economic Co-operation and Development (OECD) compared the quality of healthcare across 34 countries.

The UK lags behind in key areas, including coming 21st out of 23 countries on cervical cancer survival, 20th out of 23 countries on breast and bowel cancer survival and 19th out of 31 countries on stroke.

On heart attack deaths, the UK is ranked 20th out of 32 countries. While survival after hospital admission for heart attack and stroke is improving, it is “worse than many other OECD countries”, including Canada, Italy, the Netherlands and Spain, the study said.

The UK is also a “middling to low performer” on three out of four key health areas, including quality of care and life expectancy. Furthermore, there is a need for “urgent attention” to tackle the UK’s high rates of smoking, harmful alcohol consumption and obesity.

Some 19% of adults in the OECD are obese on average, but the figure in the UK is 25%.

Spending on health is also lower in the UK than the OECD average, with “zero growth in health spending per person in real terms between 2009 and 2013”, the report said.

Countries that spend more include France, Canada, Belgium, Germany, New Zealand and Denmark.

Nigel Edwards, chief executive of the think tank the Nuffield Trust, who helped launch the report at a meeting in central London, said thousands more doctors and nurses were needed to match the OECD average.

The UK would need 47,700 more nurses and 26,500 more doctors to match the OECD average, he said, at a cost of an extra £5 billion a year.

The OECD average number of nurses is 9.1 per 1,000 population, while the figure in the UK is 8.2.

The UK also lags behind on numbers of doctors, with 2.8 per 1,000 population, compared to the OECD average of 3.3.

Countries with more doctors include Greece, Italy, Germany, Spain, Portugal, Switzerland, the Czech Republic, Israel and Australia.

Mark Pearson, OECD deputy director of employment, labour and social affairs, said the UK was doing “outstandingly poorly” on preventing ill health by tackling issues like obesity.

He added: “While access to care in the UK is good, the quality of care is uneven and continues to lag behind that in many other OECD countries.”

He said the UK “often does not do the basic things very well”, and said the lower than average levels of public investment in healthcare was mirrored by a “somewhat mediocre performance across the board – from relatively low staffing levels, to high rates of avoidable admissions for asthma and lung disease”.

Mr Pearson said the UK “can and must do much better”, adding that in healthcare “you get what you pay for”.

The UK was spending “considerably less” on health than many of the countries it would like to compare itself to, he added.

Mr Pearson pointed to NHS achievements, including being efficient in some areas, such as lengths of stay in hospital and good performance on avoidable admissions for diabetes.

But s taffing levels were not adequate and there were still too high rates of hospital-acquired infections. Guidelines were also published but not followed, he said.

“These basic sort of things don’t seem to be done to the extent in the UK that they are done in other countries,” he said.

“I think it’s unrealistic, if you spend less, that you can expect a performance that is as good as these other countries.”

Mr Pearson said many medics were too rushed to improve the care they give.

He said: “At the moment in the NHS I think there is the risk that people do not have the time to do that.

“What they are doing is going through the processes … rather than being a learning organisation, an organisation that can improve.”

Mr Edwards added: “If people are stretched, people don’t have the bandwidth to make a change.”

Mr Edwards also said junior doctors were also relied upon to provide healthcare.

“What’s unusual about British hospitals is that when you see someone, they are quite junior.

“We use juniors to provide the backbone of the workforce in hospitals rather than (more highly qualified) doctors.”

Source Mail Online

UK falls short of 24,000 nurses due to cuts and immigration rules

Britain’s healthcare industry is suffering a nursing shortage of 24,000 staff this year, driven by a decline in student places, tougher immigration rules and spending cuts.

Despite a strong rise in EU immigration, 7,000 fewer nurses came to the UK in 2014-15 compared with 2003-04, according to Christie & Co, a consultancy.

Spanish nurses were the most likely to come here in 2015, followed by nurses from Portugal and Italy.

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The decline in overseas nurses was due in part to tougher immigration rules that mean they require pre-arranged sponsorship from an employer in the UK. In addition, they have to leave the country after a maximum of six years.

Pete Calveley, chief executive of Barchester Healthcare, the third-biggest operator of care homes in the UK and a contributor to the report, said: “We want to recruit from India, South Africa and the Philippines as these nurses are a very high calibre generally. But we cannot. We hope that with the completion of the election, the political climate will be a better one to discuss immigration policy regarding nurses. It is critical.”

But Michael Hodges, director at Christie & Co, called the shortage a “homegrown problem”, adding: “Essentially we are suffering poor workplace planning as a result of austerity measures in recent years.”

Since 2013, qualification as a registered nurse has required a three-year university degree but the number of publicly funded student places fell from 22,000 in 2008-09 to 17,000 in 2012-13. As a result 3,000 fewer graduates entered the Nursing and Midwifery Council register in 2014-15 compared with 2013-14.

Care homes — most of which are run by the private sector — are finding it hardest to recruit staff, according to the survey, which found vacancy rates were 9 per cent compared with 7 per cent in the National Health Service this year.

Over the past two years, the largest nursing home groups reported an average increase of 55 per cent in use of agency workers to fill the gaps, Christie & Co found.

The sharp rise has had a knock-on effect on costs. Agency staff cost 100 per cent more on a per hour basis than regular staff, the report said.

“Essentially we are suffering poor workplace planning as a result of austerity measures in recent years”

The NHS has also been relying more heavily on agency staff, with average health service expenditure on agency nursing estimated to have increased by 231 per cent of the past three years, according to Royal College of Nursing figures cited in the report.

Simon Stevens, NHS England chief executive, has vowed to take action over agencies “ripping off the NHS” amid reports that hospital trusts are reportedly paying up to £2,200 a shift for agency staff.

But Mr Hodges said nursing agencies were “plugging a hole and that without them the problems would be much worse”.

Staffing and low pay are a key issue in the healthcare industry. HM Revenue & Customs is investigating 100 allegations of underpayment in the sector and has promised to name and shame the offending employers. “We have started proactive investigations into six of the largest providers in the care sector,” HMRC said. “When this work is complete we will have checked the pay of around 20 per cent of the care sector workforce.”

But the industry argues that cuts in the fees paid by local authorities have eroded margins and that providers are unable to pay more.

“Operators that have a high proportion of privately funded places can subsidise the state-funded residents, but a lot of care operators are highly leveraged and the free cash flow after commitments is not very high,” said Mr Hodges.

“They need to be able to pay people a proper wage but the fees need to reflect the true cost of care and that is hard to recognise in the austerity climate.”

Source Financial Times

‘Untrained’ healthcare assistants ‘put patients at risk’

Patients are being “put at risk” because some healthcare assistants are working without proper training or supervision, a BBC investigation found.

Hospital support workers say they have been left alone on wards with up to 40 patients, with junior staff asked to take blood samples and insert IV drips.

The Royal College of Nursing blamed a “woeful lack” of trained nurses.

Health secretary Jeremy Hunt said record numbers of healthcare assistants were being trained.

The BBC has spoken to 32 care assistants from 19 hospitals across the East of England, West Midlands, East Midlands, London and South West.

The investigation found they were often asked to “act up” to perform roles designated for doctors and nurses.

Catherine Foot Catherine Foot, of the King’s Fund, said pressure on the NHS had created “an all hands on deck mentality”

National Institute for Health and Care Excellence (NICE) guidelines say healthcare assistants are expected to work under professional supervision.

One worker, who wanted to remain anonymous, said she went into surgery after two shadow shifts.

She said she touched the glove of a surgeon during an operation, forcing him to rescrub.

“I just did not know what I was doing,” she told the BBC.

Comments from healthcare assistants

“There’s not enough training, and no time to train even if we wanted to.”

“I am always asked to work above my duty – like lifting patients without lifting training.”

“HCAs are running the clinics. If something goes wrong, we have to run to get a nurse.”

“You cannot cut corners on care work. If that is the case you may as well send anybody off the street to look after people.”

“We had a patient who should have been lifted by six people being rolled only by me and one other staff member.”

“Medication has been given to the wrong people.”

Source: BBC interviews

The Department of Health says there are about 110,000 healthcare assistants across England.

Their recommended duties range from washing and dressing patients, feeding and bed making to taking blood tests and looking after wounds, depending on their seniority.

Catherine Foot, assistant director of policy at health charity the King’s Fund, said the wide range of roles meant “it is not always clear” to clinical teams what skills support workers have.

She said the government’s new care certificate, due to be introduced in April, would “provide minimum standards of training and skills”, meaning support workers are less likely to be asked to do things they are not trained for in the future.

But she said she understood how increased pressure on the health service was creating “an all hands on deck mentality”.

“It takes a lot of strength, maturity, resilience and confidence for support workers to say ‘no, I don’t know how to do that’,” she said.


NICE guidelines on health care assistants

  • There should be sufficient designated registered nurses who are experienced and trained to determine on-the-day nursing requirements
  • Staffing requirements should consider if there are enough registered nurses available to support and supervise health care assistants
  • HCAs should only be given tasks and duties within their scope of competence
  • HCAs should not be used to plug gaps in nursing shifts
  • The type of duties performed by HCAs include washing and dressing, toileting and bed making

Karen Webb, regional director of the Royal College of Nursing in the East, said a lack of nurses meant healthcare assistants were being placed in a position where they “feel they need to do work they are not educated to do”.

She said some hospitals have “a woeful lack” of qualified nurses.

“That is placing health care assistants in a dangerous situation.”

She said support workers were “left paddling around” without adequate supervision, a situation that “puts patients at risk”.

In July 2013, Sunday Times journalist Camilla Cavendish was asked by the government to review the unregistered workforce in the wake of the Francis Inquiry, which examined failings in care at Mid Staffordshire NHS Foundation Trust between 2005 and 2009.

The Cavendish Review found training for health assistants was “neither sufficiently consistent, nor sufficiently supervised”.

Mr Hunt said “no-one should do anything without the right training”, but added there were 7,500 more nurses across the country than when the coalition government came to power in 2010.

The Department of Health said it was “never acceptable for unqualified staff to be asked to undertake any task for which they are not trained or supervised”.

“Staff who raise concerns about patient safety help protect patients, and they have the government’s strong support,” a spokesman said.

“The Care Certificate, which comes into effect in April 2015, will be a means of providing clear evidence to employers, patients and service users that the healthcare assistant or social care worker in front of them has been trained to a specific set of standards.”

Sourced from the BBC Online

Mobile technology will nurse the NHS back to health

Overhauls, strategic changes, new objectives: the NHS is no stranger to grand claims and plans about the future of healthcare. 
However, all too often these plans are political footballs, doing little to improve day-to-day patient care or the working lives of frontline healthcare professionals.
We all know that in the face of budget cuts and rising admissions, NHS professionals at every level are under pressure to do more with less. 
While change in the NHS is no easy task, investment targeted in the right areas provides huge opportunities to increase efficiency, reduce costs and improve patient care. 
One recent initiative, the NHS Nursing Technology Fund, has provided some hope for those at the frontline of health services.
A recent freedom of information request submitted to NHS trusts across England highlighted that, despite the pledge to create a “paperless NHS” by 2018, two-thirds of nurses and medical staff continue to rely on handwritten notes and corridor conversations to communicate vital patient information. 
Another survey of NHS staff recently found that, although 37% of those surveyed did not have access to a Wi-Fi network installed at work, 66% felt that this would improve their ability to provide good quality care.
This system of pagers, fixed terminals and handwritten notes draws nurses away from patients. 
But sophisticated mobile communication technology could turn the situation around, allowing nurses to effectively be at their patients’ bedsides whenever required. 
Technology can identify new ways to reduce administration and speed up decision-making, knowledge transfer, delegation and equipment finding. 
The right tech means nurses can spend more time with patients, imporving the quality of care they can provide.
The key is to take advantage of opportunities such as the Nursing Technology Fund to adopt technology that makes it easier to communicate and share information on the move. 
Nursing is clearly not a sedentary role. 
If nurses are equipped with devices and tools that allow them to quickly input data, contact colleagues or respond to patients, they’ll be free to focus their attention where and when it is needed most.
Consider three simple capabilities that could run on a mobile device and improve the lives of clinical staff and patients alike:
• A smart nurse call system that can send patient alerts or lab results directly to the phone of the closest, most appropriately qualified member of staff. This means that nurses can respond to patients’ needs immediately without necessarily having to walk back to their room. The result? Peace of mind and a comprehensive view of activity on the ward.
• Barcode scanning would help ensure the right medicine is being given to the right patient or that the right person has turned up for surgery accompanied by the right paperwork. By using a device equipped with a scanner nurses can be rapidly assured that no errors have been made.
• Geo-location of vital equipment could save hours of wasted time searching the hospital and ensure essential pieces of kit are well distributed across wards. Wheelchairs, medical devices, even beds can be easily fitted with RFID tags and then identified with a mobile device, allowing nurses to find what they need quickly and easily.
• Static technology, no matter where it is located, will create delays. Short periods of time spent walking to an information source add up if repeated over the course of a long shift.
However, when we talk mobile devices we don’t mean consumer-grade smartphones and tablets. 
A day in a ward or in A&E will quickly demonstrate that these flashy bits of equipment aren’t cut out for serious work. 
In a demanding hospital environment, smartphones will be prone to breakages, water damage from chemical cleansers, drained batteries and network blackspots – leading to inconvenience, expensive repairs and an extremely high cost of ownership. 
More seriously, we saw recently that smartphones pose a hygiene risk, potentially spreading viruses like MRSA.
The NHS needs to invest in purpose-built, smart mobile communication devices if it is to improve patient experiences, nurse satisfaction and hospital efficiency. And with £70m of the Nursing Technology Fund still to be distributed, the means are finally available to make a difference.
Source The Guardian

Scottish university appoints new head of nursing

Professor Brendan McCormack has been appointed as the new head of the nursing division at Queen Margaret University in Edinburgh.

Professor McCormack will take up the post in March 2014 from his current position as director of the University of Ulster’s  Institute of Nursing and Health Research.

Dr Fiona Coutts, dean of the School of Health Sciences at Queen Margaret University, said: “Brendan’s appointment is a significant step that cements our commitment to leading the field in healthcare education.

“Brendan’s experience in nursing and allied health professional research development augments the strong inter-professional ethos of the school and will help expand our work significantly.”

Professor McCormack’s research work has focused on person-centred practice, gerontological nursing and practice development.

He also has a particular focus on the use of arts and creativity in healthcare research and development.

Professor McCormack is president of the All-Ireland Gerontological Nurses Association, chair of the charity Age Northern Ireland and a fellow/management committee member of the European Academy of Nursing Science.

Source Nursing Times

The importance of ‘healthy life expectancy’

Throughout the 1800s it hovered around the 40 years of age mark in the UK, but since the start of the 20th Century it has almost doubled.

This can be put down to a number of factors including improved health care, sanitation, immunisations, access to clean running water and better nutrition.

It means about a third of babies born today can expect to celebrate their 100th birthday.

But are we thinking about the issue in the right way?

Ministers have responded to the challenge of the ageing population by increasing the age at which people qualify for the state pension to 68 in future years.

This has been done to maintain the ratio of working-age adults to pensioners.

At the moment there are 3.7 20 to 64-year-olds for every person over 65.

If the current trend in life expectancy continues, by 2050 it will be down to 2 to 1.

It will come as no surprise that increasing working lives to 68 almost completely counteracts this.

Economic growth

But it is not quite as simple as that.

People can only work if they remain in good health – and currently the average “healthy life expectancy” is 63.5 years of age, according to the Office for National Statistics.

The problem is that a rise in life expectancy does not automatically lead to a similar rise in years spent in reasonable health.

Over the last 20 years the gap has been getting wider. Life expectancy has risen by 4.6%, but healthy life by only 3%.

So what can be done about it?

Encouraging economic growth

Change GDP percentage change

Source: Cass Business School

Life expectancy increases by 1%

-1.6%

Healthy working life increases by 1%

2.7%

Healthy retired life increases by 1%

0%

Numbers in work increases by 1%

1.6%

Productivity increases by 1%

1%

It is an issue that is being explored by the International Longevity Centre – UK, a think tank led by Baroness Sally Greengross, who recently chaired a House of Lords committee.

Prof Les Mayhew, of the Cass Business School, who acts as an adviser for the centre, believes the answer lies not in improving health care, but in investing in prevention and early intervention.

“That means addressing lifestyles, but also giving people the right support to stay healthy and independent. Social care will be critical.

“If we are not careful we will just end up in a situation where instead of people retiring there will just be more on incapacity benefit.”

‘Limited’ action

To stress his point, Prof Mayhew has carried out modelling, which shows the importance of healthy life expectancy.

He looked at various scenarios to see what effect they would have on GDP.

It shows that by far the most important factor in terms of encouraging economic growth is expanding healthy working lives by a year.

If that could be achieved, GDP would grow by 2.7% compared with 1.6% for increasing the numbers working by 1% and the 1% boost gained from a 1% increase in productivity.

Understandably, the government maintains it is taking improving the health of the nation and supporting older people seriously.

Just last week ministers in England announced more details about how the cap on elderly care costs will work.

Meanwhile, a national organisation – Public Health England – has been created to encourage lifestyle changes and councils have been given ring-fenced budgets to spend on public health schemes.

Nonetheless, in light of the recent apparent U-turns on plain packaging for cigarettes and the minimum pricing for alcohol, the suspicion persists that not enough is being done.

Prof Michael Murphy, an expert in demography from the London School of Economics, says: “Although healthy ageing and well-being are on the political agenda, actions so far have been limited.”

Source BBC News

Francis inquiry into Stafford Hospital cost government £6million

The government spent £6m on submitting evidence to the Francis inquiry into Stafford Hospital failings, Health Secretary Jeremy Hunt has revealed.

The public inquiry, led by Sir Robert Francis QC, was triggered by a higher than expected number of deaths at the Mid Staffordshire NHS Trust.

Mr Hunt provided a break down of the cost of providing evidence, in a written statement to Parliament.

It showed the majority of the £6m total (£5,227,000) was spent on legal advice.

The remainder covered the cost of dedicated staff working to prepare the evidence, their travel and subsistence expenses, and “other directly related costs”.

Mr Francis’s inquiry looked at why the scandal at Stafford Hospital – where hundreds of needless deaths were caused by abuse and neglect in 2005-08 – was not picked up earlier.

The inquiry ran for a year between 2010 and 2011, and took evidence from more than 160 witnesses over 139 days, at a cost of £13m.

More than a million pages of evidence were submitted.

The report concluded that patients had been “betrayed” because the NHS put corporate self-interest ahead of patients.

It argued for “fundamental change” in the culture of the NHS to make sure patients were put first.

In his written ministerial statement, Mr Hunt told Parliament officials had compiled the cost of submitting evidence to the inquiry.

“I can now report to the House that the expenditure incurred by the Department and NHS organisations in their role as witnesses amounted to £6m.”

He said the government would publish a further response to the Francis report this autumn.

The findings of the Francis report into failings at Mid Staffs prompted a separate review of 14 NHS hospitals in England with high mortality rates.

As a result of that review, 11 of the hospitals have been placed in “special measures” for “fundamental breaches of care”.

Source BBC News

Sustainable healthcare: trends urge need to put prevention before cure

In the long run we may all be dead but in the medium term we are increasingly being pulled into the orbit of healthcare while still alive. The fact that people around the world, whether as patients, employees or funders, are experiencing the rising share of income channelled into tackling disease has sparked a debate about sustainability.

Advances in recent decades as a result of preventive vaccines, enhanced nutrition, improved sanitation and economic growth, have all contributed to lower infant mortality and ever longer lives. Such factors mean that, although population growth is slowing, the world is inhabited by a record 7bn people.

At the same time, a shift towards more urban and sedentary lifestyles and the growing commercialisation of dense, processed and manufactured foods, have added to risks. So far, rising obesity and metabolic disorders such as diabetes in richer and poorer countries alike have failed to reverse extensions in life expectancy. But they have brought new costs through medical complications.

As birth rates decline and the population ages, the dominant types of disease have shifted and intensified, with the emergence of many more long-lasting chronic conditions, cancers and degenerative illnesses such as dementia. The ratio of working people to dependants has tipped towards the latter, increasing the pressure on funding for all.

Such tensions have long been highlighted in Europe. Following a postwar period of investment in improved healthcare in response to rising living standards and public expectations, strong government-backed health systems have come under additional budgetary constraints since the financial crisis of 2008.

In Greece, for example, there are reports of patients seeking help from humanitarian agencies after slipping through gaps in the public health system. Campaigners have pointed to a surge in HIV infections linked to the abandonment of targeted prevention programmes, notably for drug users.

In a new paper in the British Medical Journal, Helena Legido-Quigley at the London School of Hygiene and Tropical Medicine warns that, as a result of recent and planned healthcare cuts in Spain, “we are seeing detrimental effects on the health of the Spanish people and, if no corrective measures are implemented, this could worsen with the risk of increases in HIV and tuberculosis.”

In far poorer parts of the world, the crisis in agricultural supplies that, over the past few years, has prompted intense discussion on “food security” has resulted in a surge in physical and mental development problems in young children.

The economic squeeze has been reflected in healthcare problems in the US, even though its spending on health, at 18 per cent of gross domestic product, outstrips that of all other countries. But inequality of access remains a concern, with variations in cover exacerbated as people lose their jobs or move between regions and insurers.

If the United States provides some of the best, most exhaustive and innovative care in the world for those who can afford to pay, even wealthy Americans do not always enjoy better results than their peers in Europe. The poor and middle class often struggle, and co-payments and loopholes can leave them with inadequate access to treatment.

Yet there are signs of improvement, even in an age of austerity. President Barack Obama’s efforts to extend medical cover to all tapped a broader trend towards universal healthcare, reflected in policies in countries and regions as diverse as Ghana and rural China.

Jim Yong Kim, head of the World Bank, signalled a shift in policy when he told the World Health Assembly in May: “Every country in the world can improve the performance of its health system in the three dimensions of universal coverage: access, quality and affordability.”

His views chime with those of the academics David Stuckler and Sanjay Basu, who caution against a short-termist approach. In their book The Body Economic, they argue that healthcare cuts in response to austerity are counter-productive and have caused significant long-term problems such as infections and a rise in suicide rates.

There is much debate over how best to respond to budgetary pressures, with many suggesting that the introduction of “co-payments” – or the sharing of costs – by patients whenever they see a doctor discriminates against those most in need. Some argue that a more rational approach is to trim the package of available free essential care at the point of delivery.

Despite the alarm over rising costs, many in the industry downplay the concerns. Ian Read, chief executive of Pfizer, the US pharmaceutical company, says: “The question is not whether we are spending too much on healthcare, but whether we are spending enough.” He says, for example, that statins such as Lipitor, the company’s “blockbuster” cholesterol-lowering medicine, have saved healthcare systems hundreds of billions of dollars as a result of reduced heart attacks and related complications.

His argument is partly in reaction to a desire among healthcare systems to squeeze prices and demand for commodities such as drugs through “health technology assessment”.

Organisations such as the UK’s National Institute for Health and Care Excellence (Nice) judge the cost effectiveness of medicines in addition to regulators’ work on safety and efficacy.

The result, notably in Europe, has been an ever-higher hurdle for drug companies to leap in order to achieve reimbursement for their products.

That may well be justified, given an article in the latest issue of the journal Health Affairs, which has identified a consistent decline in the incremental benefits of new medicines since the 1960s.

The pharmaceutical industry is also at least partly right to highlight two other areas that merit more attention: the need for more efficiency in non-drug costs (given that medicines account for only 10-20 per cent of total expenditures) and the scope to spend less money on treatment and more on prevention.

In the US, the advent of accountable care organisations reflects an attempt to move from paying doctors per consultation towards rewarding them for improved outcomes. Similar experiments are taking place elsewhere.

Most fundamentally, demographic and disease trends alike point to the need for a substantial shift in resources and innovation towards prevention.

Some of the biggest killers, such as smoking, would appear clear candidates for more active policies – although efforts in countries such as Australia to impose plain packaging on cigarettes are meeting fierce legal resistance from the tobacco industry.

Tackling most lifestyle diseases is proving far more difficult. There are few proven models to reverse obesity, but it seems clear that there is a need for greater funding, research and political boldness. The key would be to mix behavioural science with checks on the food industry and to incorporate innovation in management, architecture and urban planning alike, to promote more healthy lifestyles.

Without greater efforts on prevention, there will be no cure for many of the diseases that develop, or the rising costs that they incur. That is certain to create new financial as well as human pain ahead.

Source Financial Times